Dentists hesitate to treat kids on Medicaid: study

NEW YORK (Reuters Health) - Dentists were less willing to see kids who needed an emergency appointment if they were covered by Medicaid than if they had private insurance in a new study based in Cook County, Illinois.

A dentist demonstrates a dental examination for a patient during a press event in a file photo. REUTERS/Phil Noble

Even dental practices that were enrolled in the state’s Medicaid and Children’s Health Insurance Program were more willing to treat a kid with private insurance than one enrolled in the state’s plan for low-income families according to the findings, which are published in Pediatrics.

“I believe it comes down to financial incentives and administrative burden,” Nancy Maserejian, a researcher at New England Research Institutes in Watertown, Massachusetts told Reuters Health in an email.

“The amount of money dental practices get paid to do the same procedure is a lot less when Medicaid is reimbursing them,” added Maserejian, who has studied access to dental care but was not involved in the current study.

It’s very possible that for people on Medicaid, access to dentists varies widely on a state-by-state basis, researchers say, since each state has its own system of paying dentists for different procedures and its own reimbursement rates.

In the current study, University of Pennsylvania’s Dr. Karin Rhodes and colleagues trained six women to pretend to be the mother of a 10-year old boy who had just broke his front tooth — an injury that requires urgent care, the authors note.

Those women made two calls to 85 different dental practices in the county, about four weeks apart, with the same story. The only difference was that one time the women told dental offices they were covered by Medicaid, and in the other call, they said the family had private Blue Cross insurance.

The order in which those calls were made was randomized for each dental practice.

In total, dentists’ offices told almost two-thirds of mothers with Medicaid that their son couldn’t get an appointment, compared to less than 5 percent of those with Blue Cross insurance.

Even among practices enrolled in Illinois’ Medicaid program, 30 percent of mothers were denied an appointment — and all of those offices were willing to make an appointment when mothers offered to pay in cash instead.

The authors note that practices not enrolled in Medicaid can still get reimbursed by the state for emergency procedures.

But Medicaid generally pays a lot less for dental procedures than private insurers — and practices may not want to deal with the hassle of billing to Medicaid.

“Often state Medicaid programs are very cumbersome,” said Tegwyn Brickhouse, the head of pediatric dentistry at Virginia Commonwealth University. “They may have varying fee schedules...it’s very complex in terms of just being able to treat the patient and file the claim,” she told Reuters Health.

Amy Martin, who has studied access to dental care at the University of South Carolina’s Arnold School of Public Health, said that although access to care is a problem in many places, these results may not generalize to other parts of the country.

Cook County — which includes the city of Chicago — is an especially wealthy area with lots of residents covered by insurance, she said, meaning that dentists can get by just fine only treating patients with private insurance.

“There’s little market motivation in Cook County to accept new patients who have Medicaid,” while that might not be the case in a poor, rural county that depends on Medicaid patients to stay in business, Martin, who was not involved with the new research, told Reuters Health.

The findings might also not apply in other states with Medicaid programs that will pay doctors more than the Illinois program, she said.

The authors noted that on average, Medicaid payments in Illinois are just over half of what dentists usually charge for services.

Previous research has shown that language and education barriers also prevent low-income people from getting health care, particularly minorities.

The findings point to a need to address the way dental practices in particular are reimbursed by Medicaid, the researchers agreed, in order to change their incentives for taking low-income patients.

And that should start before there’s a medical emergency, said Brickhouse, who was also not involved in the new study.

“The biggest thing Medicaid programs need to do is really be able to connect with the families, and help them make the right decisions about finding a dental provider,” she said.

“I think (with) prevention, you’re going to get a lot more bang for your buck if they focus on getting the child to the dentist at an earlier age.”